(405) What is the Effect on Acute Pain when a Patient's Sleep is Disturbed by Opioid-Induced Nausea and Vomiting (OINV)?

Sleep is an important factor in postoperative recovery, especially for patients experiencing moderate-to-severe acute pain. In contrast, sleep disturbance may have deleterious effects on patient recovery, including increased pain and length-of-stay. 1 However, it is unclear if nausea and vomiting interfere with sleep and with what analgesic consequence. Is there evidence of OINV-related sleep disturbance and its effect on acute pain in a randomized controlled trial (RCT)? In a previous RCT, 2 it was noted that some patients using hydrocodone 7.5mg/acetaminophen 325mg (HC/APAP) awoke with nausea, retching and/or vomiting, requesting antiemetic therapy. In the current RCT, 3 therefore, patients were observed while asleep so that emetic symptoms and pain could be documented if they awoke. Following first metatarsal bunionectomy, patients with moderate or severe pain on a categorical pain intensity scale and a 0-to-10 pain intensity scale (PI-NRS) were randomly assigned to take HC/APAP or placebo under double-blind conditions every 4-6 hours. Patients were monitored regularly as in-patients over 48 hours, including, in particular, during periods of sleeping between 9 pm and 7 am: if patients awoke from sleep, episodes of retching, vomiting and other adverse events were documented if present and patients rated nausea intensity on a 0-to-10 Likert scale and pain intensity on the PI-NRS. Of 113 HC/APAP-treated patients who developed OINV over the 48-hour treatment period, 29 patients (26%) awoke from sleep complaining of moderate-to-severe nausea, retching or vomiting, requesting an antiemetic. Compared to the summed pain intensity differences (SPID 48 ) of these patients with OINV-related sleep disturbance (63.2), SPID 48 values were 108% higher for the 137 HC/APAP-treated patients without OINV-related sleep disturbance (131.1, p